Objective:To compare the diagnostic efficacy of 18F-fibroblast activation protein inhibitor (FAPI)-42 PET/CT and 18F-FDG PET/CT for bone metastasis in patients with malignant tumors. Methods:From January 2022 to October 2023, the data of 238 patients (160 males, 78 females; age: 58(50, 66) years) with various malignant tumors who underwent both 18F-FAPI-42 and 18F-FDG PET/CT imaging at Nanfang Hospital, Southern Medical University were retrospectively reviewed. An abnormal focal radioactive uptake in bones on the PET images was considered as positive lesion for bone metastasis. The efficacy of 2imaging methods and the supplementary role of CT in the diagnosis of bone metastasis were evaluated by McNemar test. Results:Of 238 patients, 95 were with bone metastases and 143 were without bone metastases, including 436 lesions with bone metastases and 358 lesions without bone metastases. Based on the visual analysis, 18F-FAPI-42 PET showed a higher diagnostic sensitivity than 18F-FDG PET (98.4%(429/436) vs 86.5%(377/436); χ2=41.95, P<0.001), while 18F-FDG PET had a higher diagnostic specificity than 18F-FAPI-42 PET (83.2%(298/358) vs 70.4%(252/358); χ2=22.50, P<0.001), and the accuracies of both methods were similar (85.8%(681/794) vs 85.0%(675/794); χ2=0.16, P=0.685). However, when the positive lesions seen in PET were analyzed combined with the image features on CT by the same scanner, the diagnostic specificity of 18F-FAPI-42 PET/CT was significantly improved compared to that of 18F-FAPI-42 PET alone (91.3%(327/358) vs 70.4%(252/358); χ2=73.01, P<0.001), and was similar to 18F-FDG PET/CT (93.0%(333/358); χ2=0.78, P=0.377). Meanwhile, this combined analysis brought a higher sensitivity and accuracy of 18F-FAPI-42 PET/CT than 18F-FDG PET/CT in diagnosing bone metastases (sensitivity: 98.4%(429/436) vs 86.5%(377/436); χ2=41.95, P<0.001; accuracy: 95.2%(756/794) vs 89.4%(710/794); χ2=21.54, P<0.001). Conclusions:The diagnostic sensitivity of 18F-FAPI-42 PET for bone metastasis is superior to 18F-FDG PET, but the specificity is lower. However, when CT features is combined for analysis, the diagnostic specificity of 18F-FAPI-42 PET/CT is significantly improved, which thus can be used to diagnose bone metastasis accurately and is superior to 18F-FDG PET/CT.

Objective:To compare the diagnostic efficacy of 18F-fibroblast activation protein inhibitor (FAPI)-42 PET/CT and 18F-FDG PET/CT for bone metastasis in patients with malignant tumors. Methods:From January 2022 to October 2023, the data of 238 patients (160 males, 78 females; age: 58(50, 66) years) with various malignant tumors who underwent both 18F-FAPI-42 and 18F-FDG PET/CT imaging at Nanfang Hospital, Southern Medical University were retrospectively reviewed. An abnormal focal radioactive uptake in bones on the PET images was considered as positive lesion for bone metastasis. The efficacy of 2imaging methods and the supplementary role of CT in the diagnosis of bone metastasis were evaluated by McNemar test. Results:Of 238 patients, 95 were with bone metastases and 143 were without bone metastases, including 436 lesions with bone metastases and 358 lesions without bone metastases. Based on the visual analysis, 18F-FAPI-42 PET showed a higher diagnostic sensitivity than 18F-FDG PET (98.4%(429/436) vs 86.5%(377/436); χ2=41.95, P<0.001), while 18F-FDG PET had a higher diagnostic specificity than 18F-FAPI-42 PET (83.2%(298/358) vs 70.4%(252/358); χ2=22.50, P<0.001), and the accuracies of both methods were similar (85.8%(681/794) vs 85.0%(675/794); χ2=0.16, P=0.685). However, when the positive lesions seen in PET were analyzed combined with the image features on CT by the same scanner, the diagnostic specificity of 18F-FAPI-42 PET/CT was significantly improved compared to that of 18F-FAPI-42 PET alone (91.3%(327/358) vs 70.4%(252/358); χ2=73.01, P<0.001), and was similar to 18F-FDG PET/CT (93.0%(333/358); χ2=0.78, P=0.377). Meanwhile, this combined analysis brought a higher sensitivity and accuracy of 18F-FAPI-42 PET/CT than 18F-FDG PET/CT in diagnosing bone metastases (sensitivity: 98.4%(429/436) vs 86.5%(377/436); χ2=41.95, P<0.001; accuracy: 95.2%(756/794) vs 89.4%(710/794); χ2=21.54, P<0.001). Conclusions:The diagnostic sensitivity of 18F-FAPI-42 PET for bone metastasis is superior to 18F-FDG PET, but the specificity is lower. However, when CT features is combined for analysis, the diagnostic specificity of 18F-FAPI-42 PET/CT is significantly improved, which thus can be used to diagnose bone metastasis accurately and is superior to 18F-FDG PET/CT.

The patient was a 29-year-old male with a history of hemophilia for more than 10 years. After 6 hours of botulinum toxin injection into the masseter muscle, the redness and swelling of the right face gradually worsened, accompanied by local pain, and restricted mouth opening, etc. The hematoma was absorbed and the swelling subsided significantly after the infusion of coagulation factor Ⅸ. Such cases of large-scale hematomas after botulinum toxin injection in hemophiliacs is rarely reported. This article summarized the diagnosis and treatment process of this case and combines with literature review to provide clinical experience for diagnosis, treatment and prevention of similar complications.

Purpose To evaluate the added value of time of flight(TOF)and point spread dispersion(PSF)reconstruction in mediastinal lymph node metastasis of lung cancer in 18F-FDG PET/CT imaging.Materials and Methods Sixty-eight lung cancer patients with mediastinal lymph node metastasis who underwent PET/CT examination in the First People's Hospital of Foshan from March 9,2020 to July 23,2021 were analyzed retrospectively.The different methods,including ordered subsets estimation maximization(OSEM),OSEM+TOF,OSEM+PSF,OSEM+TOF+PSF,were used to reconstruct the images.The resolution of different reconstruction algorithms for mediastinal lymph node metastasis of lung cancer,as well as the differences of signal-to-noise ratio(SNR)and standard uptake value(SUV)were compared,respectively.Results The highest values of SUVmean,SUVmax and SNR were obtained via OSEM+TOF+PSF method,which increased by 21.99%,22.86%and 60.14%,compared with conventional OSEM method(t=28.321,19.11,11.059,all P<0.01).The difference percentage in smaller lesions that diameter≤22 mm was significantly higher than that in larger lesions that diameter>22 mm(24.1%vs.21.1%,25.3%vs.19.3%,70.6%vs.63.3%;Z=-3.658,-4.313,-2.154,all P<0.05),and the difference percentage in low contrast lesions that SNR≤15.31 was significantly higher than that in high contrast lesions that SNR>15.31(23.6%vs.21.4%,25.3%vs.21.1%,85.7%vs.46.0%;Z=-3.519,-2.336,-5.106,all P<0.05).Among the evaluation results of lesion detectability of different reconstruction algorithms,OSEM+TOF+PSF image showed the mediastinal lymph node metastasis most clearly(87.4%of the lesions were clearly existing),which was significantly higher than that of OSEM image(73.1%of lesions were clearly existing)(χ2=11.704,P=0.001),however,the proportion of lesions clearly existing in OSEM+PSF image did not significantly increase compared with OSEM image(73.1%vs.75.8%;χ2=0.361,P=0.548).Conclusion The combination of TOF and PSF can significantly improve the detection ability,SNR and SUV of mediastinal lymph node metastasis of lung cancer,especially in small and low contrast lesions.

Objective To investigate the effect of dapagliflozin on cardiac function and inflammatory factors of patients with type 2 diabetic mellitus(T2DM)with paroxysmal atrial fibrillation(PAF).Methods A total of 100 T2DM patients with PAF treated in Bengbu First People's Hospital from January 2021 to June 2022 were selected and divided into control group and observation group according to the treatment plan,with 50 cases in each group.Patients in both groups were given conventional treatment,and patients in observation group were given dapagliflozin on the basis of conventional treatment.Both groups were treated for 6 months.The cardiac function indexes and serum inflammatory factors were compared between two groups before and after treatment.Results After 6 months of treatment,left ventricular end diastolic diameter(LVEDD)and left atrium diameter(LAD)in both groups were significantly lower than before treatment,left ventricular ejection fraction(LVEF)was significantly higher than that before treatment,and serum hypersensitive C-reaction protein(hsCRP),interleukin-6(IL-6)and monocyte to high density lipoprotein-cholesterol ratio(MHR)were significantly lower than before treatment(P<0.05).LVEDD and LAD in observation group were significantly lower than those in control group,LVEF was significantly higher than those in control group,serum hsCRP,IL-6 and MHR were significantly lower than those in control group(P<0.05).Conclusion Dapagliflozin can significantly improve the cardiac function and reduce the level of inflammatory factors in T2DM patients with PAF,which has good clinical application value.

Objective To observe the temporary loss(re-falling)of knee range of motion(ROM)during rehabilitation after arthroly-sis for post-traumatic knee stiffness,and analyze the factors related to it. Methods From July,2016 to September,2019,64 patients(68 knees)in Beijing Bo'ai Hospital accepted minimally inva-sive arthrolysis for post-traumatic knee stiffness,and were followed up for twelve months.ROM of flexion and extension of knee was measured before operation,and one,six and twelve weeks,and six and twelve months af-ter operation;while they were asssessed with Hospital for Special Surgery Knee Score(HSS).Multivariate Logis-tic regression was performed on re-falling. Results The ROM and HSS score improved as a whole after operation;however,HSS score improved constantly,but ROM decreased six weeks after operation compared with that one weeks after operation,involving 46 knees of 44 cases.Arthrolysis longer than 12 months from primary injuries,multiple complicated fracture and history of infection were the risk factors for re-falling(OR＞8.058,P＜0.05). Conclusion Minimally invasive arthrolysis is effective on knee function after arthrolysis for post-traumatic knee stiff-ness.However,re-falling of ROM may happen during rehabilitation.Delay of operation,multiple complicated fracture and history of infection may increase the risk of re-falling.

Objective To analyze the impact of different clinical and rehabilitation characteristics on the prognosis of diabetic foot amputees. Methods Related literatures were searched in CNKI,Wanfang Data,PubMed,Cochrane Library and Google Scholar from establishment to August,2024.The literatures were screened and extracted by two researchers independent-ly,the Newcastle-Ottawa Scale(NOS)and the evaluation criteria recommended by Agency for Healthcare Re-search and Quality(US)were used for quality evaluation,and literatures with above medium quality were includ-ed,and a systematic review was conducted. Results A total of 17 articles involving 9 239 subjects were included,in which three were Chinese,and 14 were English.The study designs were case-control study,cohort study and cross-sectional study.They mainly came from the fields of rehabilitation medicine,orthopedics,sports medicine and disability studies,and were published between 1998 to 2023.Clinical and rehabilitation characteristics related to the prognosis of diabetic foot amputees includ-ed amputation level,socioeconomic determinants(educational attainment,economic status,social participation,etc.),psychological states(anxiety,depression,etc.)and physiological factors(age,gender,pain,prosthetic limb usage,and ambulatory capacity,etc.).These different characteristics could affect the quality of life of diabetic foot amputees,and even lead to re-amputation or death. Conclusion Factors of amputation level,socioeconomic status,psychological status and physiological status are impor-tant for poor prognosis in diabetic foot amputees.Controlling the above factors can effectively reduce the re-am-putation rate and mortality,and improve the quality of life in diabetic foot amputees,thus improving their progno-sis,and promoting functional rehabilitation.

The patient was a 29-year-old male with a history of hemophilia for more than 10 years. After 6 hours of botulinum toxin injection into the masseter muscle, the redness and swelling of the right face gradually worsened, accompanied by local pain, and restricted mouth opening, etc. The hematoma was absorbed and the swelling subsided significantly after the infusion of coagulation factor Ⅸ. Such cases of large-scale hematomas after botulinum toxin injection in hemophiliacs is rarely reported. This article summarized the diagnosis and treatment process of this case and combines with literature review to provide clinical experience for diagnosis, treatment and prevention of similar complications.

ObjectiveTo observe the architectural parameter changes of the muscles around the knee in middle-aged and elderly women with early knee osteoarthritis (KOA) by musculoskeletal ultrasound, and to clarify the indicators of muscles that affect early KOA. MethodsFrom January to August, 2022, 20 healthy middle-aged and elderly healthy women (controls) and 20 middle-aged and elderly women with unilateral early KOA (KOA group) were recruited through Beijing Bo'ai Hospital, to measure muscle thickness of the popliteus muscle, the muscle thickness and the pennation angle of the quadriceps, as rectus femoris, vastus intermedius, vastus lateralis, vastus medialis longus and vastus medialis oblique. ResultsCompared with the healthy limb of KOA group, and the controls, the muscle thickness of vastus medialis longus, vastus medialis oblique and popliteus muscle of the affected limb of KOA group became thinner (t > 2.133, P < 0.05); the proportion of thickness of vastus medialis oblique to thickness of vastus lateralis became smaller (t > 3.660, P < 0.05). The pennation angle was smaller in the affected limb of KOA group than in the matched dominant side of the controls (t = 3.101, P < 0.05). Logistic regression analysis showed that the muscle thickness of vastus medialis oblique (OR = 0.235, 95%CI 0.068 to 0.805, P = 0.021) and popliteus muscle (OR = 0.387, 95%CI 0.152 to 0.980, P = 0.045) were related to the onset of early KOA. ConclusionThe thickness of vastus medialis longus, vastus medialis oblique and popliteus muscle decrease, and the balance of the strength of vastus medialis oblique and vastus lateralis weakens in the affected limbs of the middle-aged and elderly women with early KOA. The thickness of vastus medialis oblique and popliteus muscle are protective factors for onset of KOA.

Objective:To evaluate the role of brain-derived neurotrophic factor-antisense long-chain non-coding RNA (BDNF-AS) in amygdala in the development of neuropathic pain (NP) in rats.Methods:Healthy clean-grade male Sprague-Dawley rats, aged 2 months, weighing 200-260 g, were used to develop NP model via ligation of left L 5-6 spinal nerve, while control group was only subjected to the exposure of L 5-6 spinal nerve without ligation.This study was performed in two parts.Experiment Ⅰ Fifty-six rats were divided into 3 groups by the random number table method: sham operation group (Sham group, n=8), NP group ( n=24) and BDNF ( n=24). In BDNF group, exogenous BDNF was injected into bilateral amygdala at 1, 3, 6, 13 and 20 days after development of the model, with 100 pmol at each side.Eight rats were sacrificed at 7, 14 and 21 days after the model was developed in NP and BDNF groups and after the model was developed in Sham group, the brains were removed, and the amygdala was isolated for determination of the BDNF content (by enzyme-linked immunosorbent assay), the number of BDNF-positive cells (by immunohistochemistry), and expression of BDNF-AS (by real-time quantitative polymerase chain reaction). Experiment Ⅱ Thirty-two rats were divided into 4 groups ( n=8 each) using the random number table method: Sham operation group, NP group, BDNF group and siRNA group.At 1, 3, 6, 13 and 20 days after development of the model, exogenous BDNF 100 pmol and siRNA-BDNF-AS 50 nmol were injected into the amygdala at each side in BDNF group and siRNA group, respectively.The mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured before development of the model (T 0) and at 4, 7, 14 and 21 days after development of the model (T 1-4). After the last behavioral test was completed, the rats were sacrificed, and the spinal cord tissues were collected to measure the contents of interleukin (IL)-1β, IL-6 and tumor necrosis factor-α (TNF-α). Results:Experiment Ⅰ Compared with Sham group, the content of BDNF and the number of BDNF positive cells were significantly decreased, and the expression of BDNF-AS was up-regulated at each time point after development of the model in group NP ( P<0.05). Compared with NP group, the content of BDNF and the number of BDNF positive cells were significantly increased, and the expression of BDNF-AS was down-regulated at each time point after development of the model in group NP ( P<0.05). Experiment Ⅱ Compared with Sham group, MWT was significantly decreased and TWL was shortened at T 1-4, and the contents of IL-1β, IL-6 and TNF-α were increased in NP, BDNF and siRNA groups ( P<0.05). Compared with NP group, MWT was significantly increased and TWL was prolonged at T 1-4, and the contents of IL-1β, IL-6 and TNF-α were decreased in BDNF and siRNA groups ( P<0.05). Conclusions:The mechanism underlying the development of NP may be related to the up-regulation of BDNF-AS expression in amygdala, inhibition of BDNF synthesis and promotion of inflammatory responses in the spinal cord of rats.